Papers of the Week

In response to the overuse of prescription opioid analgesics, clinical practice guidelines encourage opioid deprescribing (i.e. dose reduction or cessation) in patients with chronic non-cancer pain. Therefore, this study evaluated and compared international clinical guideline recommendations on opioid deprescribing in patients with chronic non-cancer pain.We searched PubMed, EMBASE, PEDro, National Institute for Health and Care Excellence (United Kingdom) and MAGICapp databases from inception to 4th June 2021, with no language or publication restrictions. Additionally, we searched The National Guideline Clearinghouse and International Guideline Network database from inception to December 2018. Two independent reviewers conducted the initial title and abstract screening. After discrepancies were resolved via discussion, two independent reviewers conducted the full-text screening of each potentially eligible reference. Four independent reviewers completed the pre-piloted, standardized data extraction forms of each included guideline. Extracted information included; bibliographical details, strength of recommendations and the outcomes; when and how to deprescribe, managing withdrawal symptoms, additional support, outcome monitoring and deprescribing in co-prescription of sedatives. A narrative synthesis was used to present the results.This study found that clinical practice guidelines agree on when and how to deprescribe opioid analgesics, but lack advice on managing a patient's withdrawal symptoms, outcome monitoring and deprescribing with co-prescription of sedatives. Quality assessment of the guidelines suggests that greater discussion on implementation and dissemination is needed.